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Why we can trust scientists with the power of new gene-editing technology

A summit of experts from around the world is meeting in Washington to consider the scientific, ethical and governance issues linked to research into gene editing. Convened in response to recent advances in the field, the summit includes experts from the US National Academy of Science, the UK’s Royal Society and the Chinese Academy of Science.

Gene editing is a new technique that allows one to change chosen genes at will. It has been applied to many organisms but a recent report from China showing the modification of human embryos using a technology known as CRISPR/Cas9 mediated editing set alarm bells ringing.

Here’s the main fear: if you modify an embryo (and therefore also its germline), you change not only the person that embryo will become but also its future sons, daughters, grandsons and granddaughters.

Since we don’t know much about this technology, it’s right to stop and think about it. But personally I’m not overly concerned: we’ve been here – or somewhere quite like it – before.

Learning from history

In 1975, scientists met at Asilomar on the Californian coast to discuss a moratorium on recombinant DNA (that’s DNA formed from combining constituents from different organisms).

Alarm bells had started ringing when scientists realised they could combine the DNA from a monkey virus with a circle of DNA called a plasmid, carrying an antibiotic resistance gene purified from the human gut bacteria, Escherichia coli (E. coli).

This cocktail sounded dangerous and scientists discussed a voluntary moratorium on certain experiments, as well as sensible guidelines for containing recombinant material within laboratories.

Why we can trust scientists with the power of new gene-editing technology - Featured Image

Horizontal gene transfer occurs in nature when DNA is carried between species by viruses and related carriers.
Jer Thorp/Flickr, CC BY

Regulations and guidelines are still in place and after 40 years few, if anyone, has been harmed by recombinant DNA. And there have been no reported outbreaks of recombinant material that have significantly affected human health or the environment.

All technologies, including different agricultural practices, have upsides and downsides, and most medicines and treatments have side effects. But recombinant DNA would now have to be classed among the least dangerous of scientific developments.

Understanding science

One reason the technology has proven so safe may be that genetic recombination has been going on for millions of years. In most cases, genes are simply passed on from parent to child. But horizontal gene transfer also occurs in nature when DNA is carried between organisms or even species by viruses.

Over time, DNA is naturally swapped around and moved. Though you may have eaten transgenic plant products, I very much doubt you’ve noticed.

There was a fear “mad scientists” would invent dangerous new superbugs and killer viruses. Perhaps this could have happened, but sadly there are enough pre-existing dangerous substances and naturally occurring diseases, which have been perfected by evolution, out there already. So germ warfare scientists are more likely to just use them.

Another fear was that researchers would modify humans. Most countries quickly outlawed the modification of human germ cells and, to my knowledge, it has never occurred. In general, scientists seem to have obeyed the regulations.

But another reason is that it has proved difficult to introduce new genes into mammalian cells. It’s legal to modify human cells, such as blood stem cells, to cure genetic diseases. But human cells are among the hardest to modify. Human “anti-viral” software seems so powerful that it inhibits the stable insertion and expression of new DNA.

The promise of gene editing

I’m sure you’ve met people who’ve had their teeth straightened or undergone cosmetic surgery. But you’ve probably never met anyone who’s had gene therapy or ever seen a transgenic animal.

Could that change with gene editing? Gene editing is so precise that one doesn’t just lob in a new gene and hope it works; what one does is edit the existing gene to eliminate any misspellings, introduce beneficial natural variants, or perhaps cut out or insert new genes into chosen locations.

Our anti-viral software may not even detect what’s happened. And provided there aren’t any “off-target’” effects, where we hit the wrong gene, there may be no or minimal side effects.

Now that it’s so easy to meddle in human genes, why shouldn’t we worry?

The new technology is a game-changer – but it’s not a runaway phenomenon, like releasing cane toads, blackberries or rabbits into Australia. After 40 years, there have been few, if any problems, with genetically modified organisms. And the experiments – though much easier now – are still so elaborate and expensive that the technology will spread slowly.

We’ll likely remain cautious about modifying human embryos and about any modification that may be passed on to the next generation. To date, consent is required for all treatments. And while patients may opt for experimental cancer therapy or surgery, we always try to think carefully when others, who cannot consent, will be affected.

Some people will even ask why it’s wrong to correct a defect that could haunt future generations. Or, if we could introduce a gene variant that protects people from cancer – such as creating a duplication of the tumour suppressor gene p53 – why wouldn’t we want that for our children?

Genetics is a branch of science that’s ripe for discussions, and conversations on recombinant DNA, gene therapy, cloning and stem cells have all gone well. Guidelines have been sensible and researchers have largely complied with them.

The very fact that people from across the world are gathering to discuss the issues surrounding the latest breakthroughs in gene technology is a very strong sign that the science will be used responsibly. One hopes that the concurrent meeting on climate change in Paris is also a victory for science.

The ConversationMerlin Crossley, Dean of Science and Professor of Molecular Biology, UNSW Australia. This article was originally published on The Conversation. Read the original article. Main photo: Libertas Academica/Flickr

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National licensing scheme for medicinal cannabis: Ley

Minister for Health Sussan Ley has announced there will be a nationally controlled licensing scheme regulating the cultivation of medical marijuana.

This scheme would reduce the need for states and territories to set up individual schemes and ensure laws are consistent for growers.

“Allowing controlled cultivation locally will provide the critical “missing piece” for a sustainable legal supply of safe medicinal cannabis products for Australian patients in the future,” she said.

Related: MJA – Medical cannabis: time for clear thinking

There has been consultation with state and territory governments and law enforcement agencies over the past month,

“We want to not only ensure these legislative amendments are rock solid, but that we can all work together to pass them in a bipartisan fashion as quickly as possible,” Ms Ley said.

“The important point is legislative changes are drafted and we’ve hit the start button for change.”

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Who are you? 7 facts about the average doctor in Australia

An annual workforce report by the Australian Institute of Health and Welfare has provided a statistical snapshot of medical practitioners in Australia.

The AIHW uses survey data from APHRA about the 98,807 medical practitioners registered in 2014, which has increased by 7.4% in two years.

Other key facts are:

1. A third of medical practitioners are GPs

In the last 10 years, there has been a steady rate of supply of general practitioners, with 111 per 100,000 population in 2014. There were 32,606 registered GPs in 2014, making up 33% of medical practitioners in Australia.

2. There are more specialists now than 10 years ago

In the last 10 years there has been growth in the rate of specialist supply, from 110 to 132 per 100,000 population. Specialists working as clinicians increased from 19,043 in 2004 to 28,403 in 2014.

3. Anaesthesia is the most common speciality

The five most common specialities account for 38.7% of clinician specialists. Anaesthesia is the most common with 3,775 or 13.3% of clinician specialists followed by psychiatry, Diagnostic radiology, General surgery and Specialist obstetrician and gynaecologist.

4. The number of female doctors is increasing

The proportion of women employed as medical practitioners has increased steadily in the past 10 years. In 2014, women made up 39.4% of the medical workforce. There are substantially more men in the older age groups and more women than men in the 20-34 age group.

Who are you? 7 facts about the average doctor in Australia - Featured Image

Graph: AIHW

5. Average age gap between men and women is decreasing

The average age of men is 48 in 2014 and has been relatively steady since 2004. The average age for women is 42 in 2014 however the average age gap over this period has narrowed slightly from 6.8 years in 2004 to 6.1 years in 2014.

6. Working hours have remained steady but on average, men work longer

The report found that medical practitioners work an average of 42.5 hours per week, which has remained steady since 2010. Men work on average 45.1 hour and women work on average 38.6 hours per week.

7. About a third of medical practitioners gained their qualifications overseas

66.4% of employed medical practitioners said they obtained their initial medical qualification in Australia. Among those who obtained their qualification overseas, those who qualified in India was the largest group followed by England and New Zealand.

Read more of the report on the AIHW website.

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‘We are professional on social media’ medical students say

The Australian Medical Students’ Association has hit back at claims that a third of medical students post inappropriate material to their social media accounts.

AMSA was responding to a recent survey, published online today in the Medical Journal of Australia, that found 34.7% of respondents reported posting unprofessional content in their social media accounts. Intoxication was the number one ‘inappropriate’ posting, followed by illegal drug use and posting of patient information.

AMSA President James Lawler said he was proud of their members and the professionalism they display on social media.

“AMSA has played a leadership role in giving students clear advice on how to manage their engagement with social media and believes the overwhelming majority of students are acting in a professional and responsible way.

Related: MJA InSight – Students behaving badly

“The MJA study clearly has a number of limitations in its methodology.

“While it makes a contribution to the debate over social media, its results need to be interpreted with caution.”

880 students voluntarily completed the survey over 6 months in 2013.

The authors of the paper, Drs  Christopher Barlow  and  Stewart  Morrison from  The  Alfred  and  St  Vincent’s, acknowledged the limitations of the study, including that it included a small proportion of the 16 993 medical students enrolled that year.They also said most of the participants were from a small number of universities which may limit the generalisation  of the results. The survey also relied on self reporting and recruitment was done on social media.

Related: Social Media for Health Professionals – Benefits and Pitfalls

35% of respondents changed their social media privacy settings as a result of the survey, suggesting that education and reminders could be a simple and effective intervention.

Mr Lawler said that social media is an important communication tool and shouldn’t be demonised.

“There are also a range of benefits from social media in medical education, such as the Free Open Access Medical Education movement ( #FOAMed).

“AMSA will continue to work closely with medical students to maximise the benefits of social media in their studies, on the path to a medical career.”

AMSA and the AMA created guidelines in 2010 for the professional use of social media for doctors and medical students.

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Doctors share their tweet-sized mental health stories

Dr Ashleigh Witt is a Melbourne based doctor who is training to be a geriatrician and writes about her experiences on her blog. Follow her on twitter. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch

A recent discussion through a series of tweets started something wonderful.

In response to our dear twitter friend @ERGoddessMD sharing her brave mental health story here, a discussion about doctor’s mental health began. @iGas2 and myself (with some creative help from @_thezol) dreamed up a hashtag doctors could use to share their tweet-length mental health struggles & triumphs. The hashtag #MH4Docs (mental health for doctors) was thus born.

I didn’t think we’d get this large response – from medical students, to registrars, to consultants in all fields of medicine, from all around the world.

This is the reminder you needed that (despite how it may seem) we all struggle. Whether it’s with that nagging social anxiety, those antidepressants no one knows about, the struggle to keep your head above water during exam time, or how much you need cycling to stay sane. Despite the fact that we might look like perfect, type A, overachievers; doctors are human too.

Here is a growing selection of #MH4Docs confessions with names changed to job titles.

140 characters is nothing, but oh God, it’s everything.

What’s your mental health story in 140 characters or less? #MH4Docs

[Paediatrician] Eating disorder for over a decade; 3 yrs of intensive OP psychiatry input & SSRIs; feeling my brain work again now. #MH4Docs

[Medical Resident] Not many people know that I take mirtazapine, so I can sleep, eat & feel joy in life. I’ve thought all day about whether to tweet. #MH4Docs

[Surgical Registrar] Increasing anxiety in med school + miscarriage = adjustment disorder with 6 mo on antidepressants. After, felt more “me” again #MH4Docs

[GP] 20 years sobriety #MH4Docs

[Medical Registrar] Treatment resistant depression, relapsed because of bullying at work. Lifelong antidepressants & ok with that. #MH4Docs

[ED Consultant] Once spent three days as a voluntary patient. Lithium side effects suck. Things get better #MH4Docs

[ICU Consultant] Depression with severe psychomotor retardation. Losing the ability to speak without great effort is a scary place to be #MH4Docs

[Cardiologist] History of depression controlled well till bullying episodes now getting back to normal spreading the word @beyondblue #MH4docs

[Geriatrician] I fought with depression and anxiety but running, yoga, healthy eating and my family have helped me to stop fighting #MH4Docs

[Med student] Started SSRI + psychotherapy this year for longstanding anxiety. Solid decision, a work in progress. #MH4Docs

[Med student] Battled with anxiety and depression since yr 11. Wouldn’t still be in med without my counsellor, dog, friends, family! #MH4Docs

[Intern] Developed Situational Depression this year due to bullying at work. On SSRIs. Still struggling. Taking it one day at a time. #MH4Docs

[Anaesthetics Registrar] My bestie died in April. He was many things; the best doctor, brilliant, committed, overworked, unsupported, depressed. #MH4Docs

[Medical Student] struggled since teens, attempts at therapy for 4 yrs, finally found right psych this yr & now better than ever #MH4Docs

[Medical Student] Am open re bipolar diagnosis. I was reported as student to med school Professional Behaviour Committee. Was meant supportively, but felt like Typhoid Mary #MH4Docs

[Medical Student] CBT/psychotherapy for mild social anxiety. Took courage to take the first step but my psychologist was wonderful #MH4Docs

[Emergency Consultant] Some days are better than others. Supportive hubby & 4 girls that make my heart swell keep me going #MH4Docs

[Medical Student] Born obsessive compulsive. Battled anorexia. Became happy #MH4Docs

[Emergency Registrar] it’s a rocky, lonely road filled with bouts of anxiety and insomnia #MH4Docs

[Medical Student] Struggled through year 1 and 2 of med with depression and anxiety. It sucked. But learnt to look after my wellbeing = worth it #MH4Docs

[Emergency Consultant] I’m the ultimate cliche: Emergency doc with ADHD. On meds I’m more calm, patient, and focused. #MH4docs

[Geriatrics Registrar] Depression triggered by shift work…factored into my choice of specialty. Was labelled “unreliable” & “emotional” RMO by med admin

[Surgical Registrar] I don’t do very well in winter. Seasonal Affective Disorder means I’m a whole lot better in Australia. #MH4Docs

[Physician] Coming out! Depression since 17. No Rx until 32 because fear of stigma. Still a rocky rd but#MH4Docs ++important.

[Physician] Anxiety for 25yrs +. Some days better than others. Soothed by walking, baking, reading, time with family & friends. #MH4Docs

[ENT surgeon] “Am I good enough? Have I got what it takes to operate on infants & walk with cancer patients at end of lives?” #MH4Docs

[ED registrar] my #MH4Docs story is a long standing eating disorder often triggered by periods of huge anxiety

[Resident] Posting this terrifies me…but recovery from bulimia is one of my proudest achievements. I wish I felt it was ok to talk about it #MH4Docs

[Resident] Antidepressants before Med school, counselling and CBT within Med school, now I look after other’s mental health! #MH4Docs

[Resident] I took a year out of med school, had days off work sick for mental health reasons. Not end of the world & nothing to be ashamed of! #MH4Docs

[GP] Antenatal &Postnatal Depression, Bereavement Reaction&Social Anxiety. 18mos of SSRIs (now finished) then 18mos of therapy (ongoing) #MH4Docs

[Consultant] Depression is devastating & disabling but thankfully I found recovery is possible. It is not a weakness & no-one should be ashamed #MH4Docs

[Medical student] Depression, anxiety, admission. Last one the scariest bc #stigma but I’m well & happy now, abt to graduate! #MH4Docs

[GP] Suicide survivor during med school. On antidepressant meds since 25 yo. Compassionate doctor#MH4Docs

[GP] As stress mounted from work, the arguments increased at home. The game changer in our marriage has been talking to a professional #MH4Docs

Please, keep sharing.

This blog was previously published on Dr Ashleigh Witt’s blog and has been republished with permission. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch

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Social Media for Health Professionals – Benefits and Pitfalls

Welcome to our doctorportal blog section. If you have a blog topic you would like to write for doctorportal, please get in touch!

I am an avid user of social media – mostly Twitter, Facebook, and WordPress – predominantly for educational and professional purposes.  As a health practitioner, I am well aware that there are concerns about the use of social media for professionals, and that many are still reluctant to engage with social media for fear of getting in trouble, or simply because they can’t understand why they should bother.  This is actually a really good place to start; safety, confidentiality and professionalism are of the utmost importance when it comes to health professionals using social media.

I was first introduced to Twitter for professional purposes during General Practice Registrars Australia (GPRA)‘s “Breathing New Life into General Practice” conference (now the “Future of General Practice” conference) in early 2012, however I must admit that it took me a while to figure out the best way to use social media, rather than just for passing time with my short attention span!  I have already recorded a 5-minute video podcast on this blog site regarding the how and why of social media for health professionals, so if this suits you better, you can find it here.  Otherwise I am going to flesh out why I bother using social media as a rural GP in Australia in this post.

There are multiple reasons for engaging online with social media, including (but not limited to) medical teaching and learning, patient education and health promotion, advocacy, networking and staying up to date.

The most exciting aspect of using social media in my opinion is the expanding world of Free Open Access Medical Education (FOAM/FOAMed/FOAM4GP), especially for isolated rural clinicians.  Believe it or not, there are hundreds of intelligent, highly skilled, altruistic health professionals out there who are willing to share their knowledge and skills with you.  For free.  No strings attached.  Anytime, anywhere, via social media.  The most enthusiastic and dedicated of these have been (and still are) those working in emergency, critical care and pre-hospital/retrieval medicine.  Some of these greats include Dr. Mike Cadogan (@sandnsurf), Dr. Chris Nickson (@precordialthump) and the team at Life In The Fast Lane, Dr. Casey Parker (@broomedocs) of Broome Docs, Dr. Minh Le Cong (@ketaminh) of PHARM, and Dr. Tim Leeuwenburg (@KangarooBeach) of KI Doc.  There is also an expanding group of enthusiastic GPs contributing to this space through the FOAM4GP blog or their own work, including Dr. Rob Park (@Robapark), Dr. Penny Wilson (@nomadicgp), Dr. Edwin Kruys (@EdwinKruys), Dr. Gerry Considine (@ruralflyingdoc) and Dr. Ewen McPhee (@Fly_texan) to name just a few!  Some health professionals have concerns about the veracity and trustworthiness of information like this online.  One could argue that peer review via social media is more rapid and critical than via any other means.  Ultimately it is still up to the individual to critically appraise online information, just as they would with any other source of information.

Social Media for Health Professionals – Benefits and Pitfalls - Featured Image

 

Producing material for FOAMed is also a wonderful way to learn and stay up to date.  In the lead up to the RACGP examinations in 2013, several GP registrars, including myself, shared information and ideas, as well as asking questions on Twitter, using the hashtag #GPexams13.  I have since produced a blog post on my study tips for GP registrars as they prepare for their RACGP exams (I can’t comment on ACRRM examinations as I have not sat them).

Health promotion activities are so much easier these days with the rapid and broad dissemination of public health information via social media platforms.  Advocacy campaigns are cheap, easy and extremely effective using social media.  #scrapthecap, #interncrisis, #copaynoway are just a few of the more successful social media campaigns which have been responsible for positive changes in government policy.  Grass-roots campaigns gain momentum quickly through social media.  Two people taking advocacy to the next level on social media are Dave Townsend, medical student and aspiring GP (@futuregp) and Alison Fairleigh, passionate rural mental health advocate (@AlisonFairleigh).  I encourage you to check out their extensive and powerful work online.

Social Media for Health Professionals – Benefits and Pitfalls - Featured Image

Professional isolation is a very real problem for rural practitioners, however social media has been a wonderful way to overcome this, through online networks of like-minded practitioners in similar situations, who can support one another and share ideas from afar.  There are many different Tweet Chats, for example #hcsm (Health Care Social Media) and closed Facebook groups where health professionals can interact online to share ideas and support one another.

I mentioned earlier about my short attention span…sometimes it is nice to just be able to flick through the headlines on Twitter and pick and choose the articles that interest me to either read now or later.  It is a quick and easy way to ensure that you stay up to date with medical news and politics as well as new research findings.  The good thing about Twitter is that you can follow the people or companies that interest you, when you have time.  One of the pitfalls of this, however, is social media addiction; we need to be wary of being antisocial whilst using so-called “social” media!  Another pitfall is the ease and speed with which a person can send out a Tweet or a Facebook post.  If you are going to post more than just an opinion or a quote, keep “The Credible Hulk” in the back of your mind, and make sure that you back up and reference your post with credible sources.

Finally, coming back to the safety concerns around professionals using social media.  It comes down to common sense; if you wouldn’t say it in a crowded elevator, then don’t put it online.  There are a multitude of social media policies and guidelines, indluding AHPRA guidelines. The social media guideline from the Canadian Medical Association is another useful document to have a look at.

In summary, social media use by health professionals has many benefits, including professional support and networking, education, public health promotion and advocacy.  Use of social media requires a common sense approach, keeping basic guidelines for safety, confidentiality and professionalism in mind.  It would be rather sad for people to decide not to use social media at all simply because of safety concerns.  I encourage all health professionals to consider branching out into social media, as it is where a lot of our patients are.  Have fun!

This blog was previously published on Dr Melanie Considine’s blog Green GP and has been republished with permission. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

Medical Research Future Fund “What’s the fuss?” campaign launched

A new community-led campaign hopes to build awareness among Australians about the importance of the Medical Research Future Fund.

The television and online campaign features Carrie Bickmore, Ita Buttrose, Natasha Stott Despoja, and former Australians of the Year Sir Gustav Nossal and Professor Patrick McGorry.

It will ask “What’s the fuss?” about medical conditions such as dementia, brain cancer, heart disease, and mental illness.

Medical Research Future Fund (MRFF) Action Group Chair Peter Scott says: “The MRFF is the serious investment in health and medical research that Australia needs, and we are grateful that it is receiving the fuss it deserves thanks to so many high profile people being so generous with their time in filming with us, simply because they care so much about improved funding for medical research.

“As a protected, perpetual fund, the Australian Government’s MRFF will lead to many more medical discoveries and help us make our health system more effective and efficient by doubling the government’s investment in medical research.”

Related: MJA – Why Australia needs a medical research future fund

Scott hopes the website www.whatsthefuss.org.au will become a place where people can tell their personal stories, be they medical research success stories or about conditions that need more research.

“There are the people we’ve lost, such as our group’s founding chair, Alastair Lucas, who died of brain cancer recently. For him before he died, and for all who loved him, there was that crucial intangible that medical research delivers: hope. Hope for a treatment, for a cure. Hope is priceless.”

The Medical Research Future Fund is a protected, perpetual fund that is slated to build to $20 billion by 2020. At this point, it will deliver $1 billion in annual funding to medical research and innovation.

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Q&A: Dr Murray Haar, 2010 AMA Indigenous Peoples’ Medical Scholarship winner

Dr Murray Haar is a Wiradjuri man who is currently working at Albury Base Hospital. He won the Australian Medical Association Indigenous Peoples’ Medical Scholarship in 2010. In the lead up to the next round of scholarships being awarded, he reflects on how it helped him and what it’s like being an Indigenous doctor in Australia.

 

What’s your background and how did you decide you wanted to be in medicine.

I grew up in Punchbowl in Sydney’s south west and I had always wanted to study medicine. I was fortunate enough to go to the UNSW Winter School in years 10 and 12 which spurred my interest. I have always been interested in mental health and hope to specialise in psychiatry.

 

What was your path to medicine?

I went straight from high school into the medical degree at UNSW in 2008. In that time, I had a year away from study where I worked full time at the Kirketon Road Centre, part of what is known as the ‘injecting centre’ in Kings Cross. There my duties involved engaging with clients in health promotion, needle syringe program, groups and sexual health triage.

I completed my degree in 2014 which had six Indigenous doctors in the graduating class, one of the biggest groups in Australian medicine. I am now doing an internship and residency at Albury Base Hospital which is the county of my father’s people, the Wiradjuri nation.

 

What area of medicine interests you the most?

I want to do psychiatry to enable me to work in addiction medicine. I have been able to complete a term in psychiatry at Albury and most of my relief term was based in Nolan House, an adult inpatient unit. This experience has really enabled me to work in the area where I feel I have the most potential to make a significant difference in patient care.

Patients with a mental illness are amongst the most disadvantaged people in the community. Psychiatry can play such a powerful role to improve the lives of patients, families and communities.

 

How did the AMA Indigenous Peoples’ Medical Scholarship help you in your studies?

You need real dedication to study medicine, class contact is five days a week, and there’s heaps of study and preparation after hours. Receiving the scholarship from third year onwards helped me give my studies everything I’ve got, particularly in the last year.

I also got some great help from the UNSW’s Indigenous Unit, Nura Gili which specifically helps Aboriginal and Torres Strait Islander students with academic support and assistance navigating the university world.

 

What advice would you give other Aboriginal and Torres Strait Islander students who are thinking of studying medicine?

Don’t listen to anyone who discourages you. There is plenty of support for you, from the university, from scholarships and from other Indigenous doctors. There is improvement in the state of Indigenous health, but the gap is still wide. It’s really important that we play our part in closing it.

 

What has your experience been of being an Indigenous doctor so far? Are there any unique challenges or advantages?

I am incredibly privileged to be an Aboriginal doctor, particularly when looking after an Aboriginal patient with whom I can empathise and form an instant connection and understanding through our unique appreciation of family and connectedness. The challenges can be tough at time as the workplace is like any other and not free of racism or bullying.

 

How do you think your perspective or your path to medicine has differed as an Indigenous man?

I feel as an Aboriginal doctor you bring a unique perspective to the practice of medicine. With a set of values and respect for family, land and spirituality and an understanding of the health disparity of our peoples compared to the rest of Australians. There is still much work to be done to close the gap, but more Aboriginal and Torres Strait Islander doctors will go a long way to help this.

 

The next round of AMA Indigenous Peoples’ Medical Scholarship opens on November 1. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

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Bad times for good bacteria: how modern life has damaged our internal ecosystems

Human actions damage ecosystems on a global scale. Our influence is so great we’ve triggered a new geological epoch, called the Anthropocene, simply because of the changes we’ve brought about. But it’s not just the outside environment we’ve changed, we’ve also damaged the ecosystems inside us.

Our activities alter natural processes, such as weather patterns, and the way nutrients, such as nitrogen and phosphorus, move within ecosystems. We cause declines in species diversity, trigger extinctions and introduce weeds and pests.

All this comes with costs, caused by the increasing unpredictability of both physical and biological systems. Our infrastructure and agriculture rely on a consistent climate, but that’s now becoming increasingly unreliable. And it’s not just the outside world that’s unpredictable; it may come as a surprise to some that we have internal ecosystems, and that these have also been damaged.

Shrinking population

Every adult is made up of 100 million, million human cells (that’s a one followed by 14 zeroes). But the human body is also home to ten times this number of bacterial cells, which, collectively, are called the microbiota. Biologists have only been exploring this internal ecosystem for a decade or so, but surprising and important results are already emerging.

Bad times for good bacteria: how modern life has damaged our internal ecosystems - Featured Image

Humans damage ecosystems on an epic scale. Global Water Forum/Flickr, CC BY

Because the laboratory where I work is interested in how humans affect evolutionary processes, it was natural for us to ask how much humans might affect microbial ecosystems. The answer turns out to be quite a lot.

Possibly the most direct and personal effects are on our own microbiota. And these changes come with consequences for health and well-being. Exactly the same processes we see in external ecosystems – loss of diversity, extinction, and introduction of invasive species – are happening to our own microbiota. And damaged ecosystems don’t function as well as they should.

Scientists have tried to “go back in time” and ask what the original human microbiota might have looked like. There are three ways of doing this: biologists can look at the microbiota of our nearest relatives, the great apes; we can examine DNA from fossils; or we can look at the microbiota of modern-day humans who still have a hunter-gatherer lifestyle.

All these approaches tell the same story. Modern humans have a lower diversity of microbiota than our ancestors, and there’s been a consistent decline in this diversity across ancient and recent human history.

There are a number of reasons for the decline. The widespread use of fire from 350,000 years ago increased the calories we could obtain from food. This probably decreased our need for a big gut, and a smaller gut means less room for microbes.

The invention of agriculture between 8,000 and 10,000 years ago changed our diet, and with it, our microbiota. The end result was the extinction of some components of the microbiota in farming populations. Even today, hunter-gatherers and subsistence societies have many bacterial species in their gut that are never found in the guts of people from westernised societies.

Bad times for good bacteria: how modern life has damaged our internal ecosystems - Featured Image

One of the last hunter-gatherer societies in the world, the Yanomami people of South America, have a highly diverse and stable microbiota, and don’t suffer from diseases common in the developed world. christian caron/Flickr, CC BY-ND

Modern onslaught

Changes in microbiota have been tracked using bacteria preserved on the teeth of skeletons, and this showed falls in diversity linked to dietary changes, as well as a shift to microbial species associated with disease.

The changes are particularly apparent after the Industrial Revolution, when processed flour and sugar became widely available. And diet continues to have a major influence on our microbiota.

But the greatest disruption probably happened after the 1950s. This time period corresponds to a number of changes that directly affect the composition of the human microbiota. One involves the opportunity for microbiota to colonise newborns and infants. Normally, babies obtain some microbiota from their mother during childbirth, but caesarean births interrupt this opportunity. Bottle feeding, increased sanitation, and eating processed, sterile foods also limit opportunities to acquire microbiota.

Modern medicine has been very successful at controlling bacterial diseases with antibiotics. Unfortunately, antibiotics cause considerable collateral damage to innocent and beneficial bacteria. After antibiotic therapy, the microbiota may never return to their original abundance, and genetic diversity is reduced in those bacteria that remain.

Bad times for good bacteria: how modern life has damaged our internal ecosystems - Featured Image

 

Antibiotics can also damage beneficial bacteria. Photo: Shutterstock

Collectively, these changes mean that our microbial ecosystems have become degraded, much like natural ecosystems globally. The microbiota are less functional and resilient than they should be. And it turns out they have essential roles in developing our immune systems, and in regulating metabolism. So it shouldn’t be surprising that altered microbiota are now being associated with many diseases of the modern world.

These diseases include obesity, allergic reactions, chronic inflammatory conditions and autoimmune disorders. More recently, it’s also been suggested that psychological conditions, such as depression and anxiety, are linked to the bacteria that live inside us.

In some cases, the parallels with more conventional ecosystems are clear. Clostridium difficile is a bacterium that can grow out of control in our gut, like an invasive weed. And, like a weed invading degraded land, it often spreads rapidly after other bacteria have been eliminated from the gut by antibiotics. The most effective cure is similar to bush regeneration; donating microbiota from healthy volunteers (a “poo transplant”) helps restore a healthy ecosystem.

But, for many diseases associated with our microbiota, there are no immediate cures. Like most ecosystems, our gut bacteria are complex and dynamic. The challenge now is to understand this system and how to acquire and maintain a healthy microbiota, so that in the future, a microbiota check-up might be a routine part of a visit to the doctor.

In such a future, hunter-gatherers such as the Yanomami of the Amazon may turn out to be the custodians of valuable species that are extinct in the microbiota of the developed world.

 

This article was originally published on The Conversation. Read the original article.

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